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Yu JL, Jiang LL, Dong R, Liu SY. Intracranial infection and sepsis in infants caused by Salmonella derby: A case report. World J Clin Cases 2023; 11:6961-6966. [PMID: 37901018 PMCID: PMC10600864 DOI: 10.12998/wjcc.v11.i28.6961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 08/20/2023] [Accepted: 09/06/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND Salmonella derby (S. derby) is a Gram-negative diplococcus that is common in the digestive tract. Infected patients generally experience symptoms such as fever and diarrhea. Mild cases are mostly self-healing gastroenteritis, and severe cases can cause fatal typhoid fever. Clinical cases are more common in children. The most common form of S. derby infection is self-healing gastroenteritis, in which, fever lasts for about 2 d and diarrhea for < 7 d. S. derby can often cause bacterial conjunctivitis, pneumonia, endocarditis, peritonitis and urethritis. However, intracranial infections in infants caused by S. derby are rare in clinical practice and have not been reported before in China. CASE SUMMARY A 4-mo-old female infant had recurrent fever for 2 wk, with a maximum body temperature of around 39.4°C. Treatment for infectious fever in a local hospital was ineffective, and she was admitted to our hospital. Before admission, there was one sudden convulsion, characterized by unclear consciousness, limb twitching, gaze in both eyes, and slight cyanosis on the face. Cerebrospinal fluid (CSF) culture was positive for Gram-negative bacilli, which conformed to S. derby. After treatment with meropenem and ceftriaxone antibiotics, the patient was discharged home in a clinically stable state after 4 wk of treatment. CONCLUSION We reported a rare case of S. derby cultured in CSF. S. derby enters the CSF through the blood-brain barrier, causing purulent meningitis. If not treated timeously, it can lead to serious, life-threatening infection.
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Affiliation(s)
- Jing-Lu Yu
- Department of Clinical Laboratory, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui 323000, Zhejiang Province, China
| | - Li-Li Jiang
- Department of Clinical Laboratory, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui 323000, Zhejiang Province, China
| | - Rong Dong
- Department of Neonatology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui 323000, Zhejiang Province, China
| | - Si-Yu Liu
- Department of Clinical Laboratory, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui 323000, Zhejiang Province, China
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2
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Shome A, Da Silva PP, Wenger PN, Kumta JN. Neonatal Salmonella Meningitis With Subdural Empyema: A Case Report. Pediatr Infect Dis J 2023; 42:e390-e392. [PMID: 37310891 DOI: 10.1097/inf.0000000000003996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Ashna Shome
- Department of Pediatrics Jacobi Medical Center New York, NY
| | - Poliana P Da Silva
- Department of Pediatrics, Children Hospital of New Jersey at Newark Beth Israel, RWJ Barnabas Health, Newark, New Jersey
| | - Peter N Wenger
- Department of Pediatrics, Children Hospital of New Jersey at Newark Beth Israel, RWJ Barnabas Health, Newark, New Jersey
| | - Jayshree N Kumta
- Department of Pediatrics, Children Hospital of New Jersey at Newark Beth Israel, RWJ Barnabas Health, Newark, New Jersey
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3
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Majeed I, Khan SU, Khan ZR, Hayat S, Ullah I, Ali A. Salmonella meningitis in a young child from Pakistan: a case report. J Med Case Rep 2023; 17:390. [PMID: 37705001 PMCID: PMC10500717 DOI: 10.1186/s13256-023-04128-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/14/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Salmonella meningitis is a rare but serious complication of Salmonella infection, primarily affecting infants, children, and immunocompromised individuals. CASE PRESENTATION We present a case of a two-and-a-half-year-old Asian boy who developed Salmonella meningitis along with pneumonia and respiratory failure. Initially, he experienced symptoms of loose motions, fever, and irritability, which progressed to neck stiffness and brisk reflexes. Cerebrospinal fluid (CSF) analysis confirmed Salmonella typhi in the CSF. Due to the worsening condition, the patient was admitted to the intensive care unit, intubated, and switched to meropenem as the antibiotic of choice after an initial empiric therapy with ceftriaxone and vancomycin. With appropriate treatment, the patient showed significant improvement, including resolution of fever and respiratory symptoms. CONCLUSION Management of Salmonella meningitis is often challenging primarily because of the fact that the empiric therapy for meningitis may not always provide coverage to the multi-drug resistant Salmonella species found in South Asia. Prompt administration of appropriate antibiotics based on sensitivity testing is crucial for successful management. This case emphasizes the importance of early recognition and effective management of this uncommon yet severe complication of Salmonella infection.
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Affiliation(s)
| | | | | | | | | | - Asim Ali
- Lady Reading Hospital, Peshawar, Pakistan
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4
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Self JL, Judd MC, Huang J, Fields PI, Griffin PM, Wong KK. Epidemiology of Salmonellosis Among Infants in the United States: 1968-2015. Pediatrics 2023:191251. [PMID: 37161700 DOI: 10.1542/peds.2021-056140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/10/2023] [Indexed: 05/11/2023] Open
Abstract
OBJECTIVES Describe characteristics of gastroenteritis, bacteremia, and meningitis caused by nontyphoidal Salmonella among US infants. METHODS We analyze national surveillance data during 1968-2015 and active, sentinel surveillance data during 1996-2015 for culture-confirmed Salmonella infections by syndrome, year, serotype, age, and race. RESULTS During 1968-2015, 190 627 culture-confirmed Salmonella infections among infants were reported, including 165 236 (86.7%) cases of gastroenteritis, 6767 (3.5%) bacteremia, 371 (0.2%) meningitis, and 18 253 (9.7%) with other or unknown specimen sources. Incidence increased during the late 1970s-1980s, declined during the 1990s-early 2000s, and has gradually increased since the mid-2000s. Infants' median age was 4 months for gastroenteritis and bacteremia and 2 months for meningitis. The most frequently reported serotypes were Typhimurium (35 468; 22%) for gastroenteritis and Heidelberg for bacteremia (1954; 29%) and meningitis (65; 18%). During 1996-2015 in sentinel site surveillance, median annual incidence of gastroenteritis was 120, bacteremia 6.2, and meningitis 0.25 per 100 000 infants. Boys had a higher incidence of each syndrome than girls in both surveillance systems, but most differences were not statistically significant. Overall, hospitalization and fatality rates were 26% and 0.1% for gastroenteritis, 70% and 1.6% for bacteremia, and 96% and 4% for meningitis. During 2004-2015, invasive salmonellosis incidence was higher for Black (incident rate ratio, 2.7; 95% confidence interval, 2.6-2.8) and Asian (incident rate ratio, 1.8; 95% confidence interval, 1.7-1.8) than white infants. CONCLUSIONS Salmonellosis causes substantial infant morbidity and mortality; serotype heidelberg caused the most invasive infections. Infants with meningitis were younger than those with bacteremia or gastroenteritis. Research into risk factors for infection and invasive illness could inform prevention efforts.
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Affiliation(s)
- Julie L Self
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, CSELS, and
- Enteric Diseases Epidemiology Branch, Division of Foodborne, Waterborne, and Environmental Diseases, NCEZID, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael C Judd
- Enteric Diseases Epidemiology Branch, Division of Foodborne, Waterborne, and Environmental Diseases, NCEZID, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer Huang
- Enteric Diseases Epidemiology Branch, Division of Foodborne, Waterborne, and Environmental Diseases, NCEZID, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Patricia I Fields
- Enteric Diseases Epidemiology Branch, Division of Foodborne, Waterborne, and Environmental Diseases, NCEZID, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Patricia M Griffin
- Enteric Diseases Epidemiology Branch, Division of Foodborne, Waterborne, and Environmental Diseases, NCEZID, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Karen K Wong
- Enteric Diseases Epidemiology Branch, Division of Foodborne, Waterborne, and Environmental Diseases, NCEZID, Centers for Disease Control and Prevention, Atlanta, Georgia
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5
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Dange NS, Sawant V, Dash L, Kondekar AS. A Rare Case of Salmonella meningitis and Hemophagocytic Lymphohistiocytosis. J Glob Infect Dis 2021; 13:100-102. [PMID: 34194179 PMCID: PMC8213079 DOI: 10.4103/jgid.jgid_224_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/09/2020] [Accepted: 09/21/2020] [Indexed: 11/29/2022] Open
Abstract
Enteric fever is a common infectious disease of the tropical world. Common age group involved is children aged between 5 and 10 years. In addition to diarrhea, it may lead to extraintestinal infections including aseptic meningitis, hepatitis, cholecystitis, acute abdomen, intestinal perforation, pneumonia, psychosis, and ataxia. Hematologic complications leading to hemophagocytosis have a prevalence of < 1%. Salmonella meningitis has an incidence of 6% with poor prognosis neurological sequelae. We report a rare case of enteric fever that presented with hemophagocytic syndrome and S. meningitis. Response to third-generation cephalosporins is dramatic, eventually giving good prognosis.
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Affiliation(s)
- Nimisha S Dange
- Department of Pediatrics, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Vishal Sawant
- Department of Pediatrics, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Lona Dash
- Department of Microbiology, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Alpana Santosh Kondekar
- Department of Pediatrics, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
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6
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Mohan A, Munusamy C, Tan YC, Muthuvelu S, Hashim R, Chien SL, Wong MK, Khairuddin NA, Podin Y, Lau PST, Ng DCE, Ooi MH. Invasive Salmonella infections among children in Bintulu, Sarawak, Malaysian Borneo: a 6-year retrospective review. BMC Infect Dis 2019; 19:330. [PMID: 30999894 PMCID: PMC6471830 DOI: 10.1186/s12879-019-3963-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 04/08/2019] [Indexed: 11/17/2022] Open
Abstract
Background Invasive Salmonella infections result in significant morbidity and mortality in developing countries. In Asia, typhoid and paratyphoid fever are reported to be the major invasive Salmonella infections, while invasive non-typhoidal Salmonella (iNTS) infections are believed to be uncommon. Data from Sarawak, in Malaysian Borneo, are limited. Methods A retrospective study identifying all children aged < 15 years with invasive Salmonella infections from 2011 to 2016 was conducted in Bintulu Hospital in Sarawak. Population incidences, clinical and bacterial characteristics were examined. Results Forty-four patients were identified during the 6-year study period: 43 had iNTS infection and 1 had typhoid fever. The average annual iNTS incidence was 32.4 per 100,000 children aged < 5 years. None of the children had malaria or HIV infection, and only 7% were severely malnourished. Salmonella Enteritidis and Salmonella Java were the commonest NTS serovars identified. Pneumonia was the most common manifestation of iNTS disease, present in 20 (47%) children. Other manifestations included gastroenteritis, fever without a source, septic arthritis and meningitis. Salmonella Enteritidis was identified in 76% of those with pneumonia, significantly more frequently than in children with other manifestations. Over 25% of children with iNTS developed severe disease and nearly 10% suffered long term morbidity or mortality. While 78% of Salmonella Java isolates were multi-drug resistant, nearly all other isolates were susceptible to most antimicrobials, including ampicillin. Conclusions Bintulu Division in Sarawak observed a very high incidence of childhood iNTS infections. Enteric fever was uncommon. The epidemiology of invasive Salmonella infections in Malaysian Borneo differs considerably from that of neighbouring countries in Asia.
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Affiliation(s)
- Anand Mohan
- Department of Paediatrics, Bintulu Hospital, Bintulu, Sarawak, Malaysia. .,Institute of Health and Community Medicine, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia.
| | - Chandran Munusamy
- Department of Paediatrics, Bintulu Hospital, Bintulu, Sarawak, Malaysia
| | - Yee-Chin Tan
- Department of Paediatrics, Bintulu Hospital, Bintulu, Sarawak, Malaysia
| | - Sobana Muthuvelu
- Department of Paediatrics, Bintulu Hospital, Bintulu, Sarawak, Malaysia
| | - Rohaidah Hashim
- Bacteriology Unit, Infectious Disease Research Centre, Institute for Medical Research, Kuala Lumpur, Malaysia
| | - Su-Lin Chien
- Department of Pathology, Bintulu Hospital, Bintulu, Sarawak, Malaysia
| | - Ming-Kui Wong
- Department of Pathology, Bintulu Hospital, Bintulu, Sarawak, Malaysia
| | | | - Yuwana Podin
- Institute of Health and Community Medicine, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | | | - David Chun-Ern Ng
- Department of Paediatrics, Bintulu Hospital, Bintulu, Sarawak, Malaysia.,Department of Paediatrics, Hospital Tuanku Ja'afar, Seremban, Negeri Sembilan, Malaysia
| | - Mong-How Ooi
- Institute of Health and Community Medicine, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia.,Department of Paediatrics, Sarawak General Hospital, Kuching, Sarawak, Malaysia
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7
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Williams V, Lakshmikantha KM, Nallasamy K, Sudeep KC, Baranwal AK, Jayashree M. Subdural empyema due to Salmonella paratyphi B in an infant: a case report and review of literature. Childs Nerv Syst 2018; 34:2317-2320. [PMID: 29748704 DOI: 10.1007/s00381-018-3825-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 05/04/2018] [Indexed: 11/27/2022]
Abstract
Intracranial infection due to Salmonella is uncommon in children. Subdural empyema (SDE) is described with Salmonella typhi as a complication of meningitis. We report a 6-month-old infant with SDE secondary to Salmonella paratyphi B who had presented with prolonged fever and enlarging head. A literature review of Salmonella SDE in infants with respect to clinical course and outcome is presented.
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Affiliation(s)
- Vijai Williams
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, PGIMER, Chandigarh, 160012, India
| | | | - Karthi Nallasamy
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, PGIMER, Chandigarh, 160012, India.
| | - K C Sudeep
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, PGIMER, Chandigarh, 160012, India
| | - Arun Kumar Baranwal
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, PGIMER, Chandigarh, 160012, India
| | - Muralidharan Jayashree
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, PGIMER, Chandigarh, 160012, India
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8
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Salmonella typhimurium Meningitis in an Infant Presenting with Recurrent Meningitis. Indian J Pediatr 2018; 85:560-562. [PMID: 29238942 DOI: 10.1007/s12098-017-2562-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 11/24/2017] [Indexed: 10/18/2022]
Abstract
Salmonella typhimurium meningitis in infancy is very uncommon and does not respond to usual duration of empirical antibiotic therapy. A 5-mo-old infant presented with clinical picture of acute pyogenic meningitis and was treated with empirical antibiotic therapy for 14 d. But, 2 wk after the discharge, the child presented again with similar complaints. CSF culture had grown Salmonella typhimurium following which dual antibiotic therapy was given for 6 wk.
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9
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Bauler TJ, Starr T, Nagy TA, Sridhar S, Scott D, Winkler CW, Steele-Mortimer O, Detweiler CS, Peterson KE. Salmonella Meningitis Associated with Monocyte Infiltration in Mice. THE AMERICAN JOURNAL OF PATHOLOGY 2016; 187:187-199. [PMID: 27955815 DOI: 10.1016/j.ajpath.2016.09.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 09/12/2016] [Accepted: 09/19/2016] [Indexed: 01/22/2023]
Abstract
In the current study, we examined the ability of Salmonella enterica serovar Typhimurium to infect the central nervous system and cause meningitis following the natural route of infection in mice. C57BL/6J mice are extremely susceptible to systemic infection by Salmonella Typhimurium because of loss-of-function mutations in Nramp1 (SLC11A1), a phagosomal membrane protein that controls iron export from vacuoles and inhibits Salmonella growth in macrophages. Therefore, we assessed the ability of Salmonella to disseminate to the central nervous system (CNS) after oral infection in C57BL/6J mice expressing either wild-type (resistant) or mutant (susceptible) alleles of Nramp1. In both strains, oral infection resulted in focal meningitis and ventriculitis with recruitment of inflammatory monocytes to the CNS. In susceptible Nramp1-/- mice, there was a direct correlation between bacteremia and the number of bacteria in the brain, which was not observed in resistant Nramp1+/+ mice. A small percentage of Nramp1+/+ mice developed severe ataxia, which was associated with high bacterial loads in the CNS as well as clear histopathology of necrotizing vasculitis and hemorrhage in the brain. Thus, Nramp1 is not essential for Salmonella entry into the CNS or neuroinflammation, but may influence the mechanisms of CNS entry as well as the severity of meningitis.
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Affiliation(s)
- Timothy J Bauler
- Laboratory of Bacteriology, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana
| | - Tregei Starr
- Laboratory of Bacteriology, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana
| | - Toni A Nagy
- Department of Molecular, Cellular and Developmental Biology, University of Colorado Boulder, Boulder, Colorado
| | - Sushmita Sridhar
- Laboratory of Bacteriology, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana
| | - Dana Scott
- Rocky Mountain Veterinary Branch, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana
| | - Clayton W Winkler
- Laboratory of Persistent Viral Diseases, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana
| | - Olivia Steele-Mortimer
- Laboratory of Bacteriology, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana
| | - Corrella S Detweiler
- Department of Molecular, Cellular and Developmental Biology, University of Colorado Boulder, Boulder, Colorado
| | - Karin E Peterson
- Laboratory of Persistent Viral Diseases, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana.
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10
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Salmonella berta meningitis in a term neonate. J Perinatol 2014; 34:798-9. [PMID: 25263727 DOI: 10.1038/jp.2014.98] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 04/08/2014] [Accepted: 04/15/2014] [Indexed: 11/08/2022]
Abstract
We report the case of a 37-week male infant born via spontaneous vaginal delivery who developed Salmonella berta sepsis and meningitis. The infant was born to a mother with active diarrhea and stool cultures growing S. berta. On day 3, the infant developed poor feeding, lethargy, apnea and bradycardia prompting a sepsis evaluation. Blood, stool and cerebrospinal fluid cultures were positive for S. berta. An electroencephalogram performed for posturing revealed neonatal status epilepticus. Extensive bilateral periventricular venous hemorrhagic infarctions with multiple herniations were seen on brain magnetic resonance imaging. The infant's condition continued to deteriorate despite maximal support and care was redirected towards comfort measures.
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Abstract
We report a case of meningitis due to Salmonella typhimurium in a four-month-old female infant. The child was brought to the pediatric emergency department with complaints of fever, cold, and generalized convulsion. On examination, the child was febrile and was having seizures. The anterior fontanelle was not bulging. Lumbar puncture was done and Salmonella typhimurium was isolated from cerebrospinal fluid. Initially the infant improved clinically with appropriate management, but had a fatal outcome due to nosocomial pneumonia.
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Affiliation(s)
| | - Sangeeta Joshi
- Department of Microbiology, Manipal Hospital, Bangalore, India
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12
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Salmonella enterica Serotype Enteritidis Meningitis in a 4-Day-Old Neonate. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2014. [DOI: 10.1097/ipc.0b013e318280d927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Mahalakshmi R, Rajeshbabu B, Mohan R, Balakumaran D, Venkataraman P, Ponnurangam Nagarajan V. Salmonella paratyphi B meningitis in an infant. Australas Med J 2013; 6:350-3. [PMID: 23940494 DOI: 10.4066/amj.2013.1667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We report a case of Salmonella paratyphi B meningitis in a 90 day-old male infant who was admitted with complaints of fever, vomiting and one episode of vacant stare. Clinically, the infant was found to be toxic and dull with a bulging anterior fontanelle. Subsequently, blood and cerebrospinal fluid cultures demonstrated the presence of Salmonella Paratyphi B organism.
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Affiliation(s)
- Rajan Mahalakshmi
- Sri Ramachandra Medical College & Research Institute, Chennai, Tamil Nadu, India
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14
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Epidemiology, disease spectrum and economic burden of non-typhoidal Salmonella infections in Taiwan, 2006-2008. Epidemiol Infect 2012; 140:2256-63. [PMID: 22309742 DOI: 10.1017/s0950268812000088] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The purpose of this study was to understand the seasonal, geographical and clinical characteristics of Taiwanese patients hospitalized for non-typhoidal Salmonella (NTS) infections and their economic burden. Hospital data obtained from the Taiwan National Health Insurance (NHI) database between 2006 and 2008 were analysed. Infants had the highest annual incidence of 525 cases/100 000 person-years. Elderly patients aged >70 years had the highest in-hospital mortality rate (2·6%). Most (82·6%) gastroenteritis occurred in children aged <10 years. Septicaemia, pneumonia, arthritis and osteomyelitis occurred mainly in patients aged >50 years. A median medical cost for NTS-associated hospitalizations was higher for patients with septicaemia than for those with gastroenteritis. Seasonal variation of NTS-associated hospitalizations was correlated with temperature in different areas of Taiwan. In summary, infants had a high incidence of NTS-associated hospitalizations. However, the elderly had a higher in-hospital mortality rate and more invasive NTS infections than children.
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15
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Nimir AR, Ibrahim R, Ibrahim IAA. Salmonella meningitis in a paediatric patient caused by Salmonella enterica serotype Houtenae. BMJ Case Rep 2011; 2011:bcr.04.2011.4096. [PMID: 22689601 DOI: 10.1136/bcr.04.2011.4096] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The authors report a case of a 6-week-old baby girl who was admitted to the paediatric ward due to a high fever for 2 days. The patient experienced three fits which took place while in the ward. A brain sonogram showed subdural heterogeneous collection consistent with focal empyema; however, no hydrocephalus or infarction was detected. An urgent Burr hole procedure was performed to remove the collected pus. Both blood and cerebrospinal fluid (CSF) culture grew Salmonella species which remain sensitive to some antibiotics. This strain was sent to the institute of medical research (IMR) for serotyping. The patient was treated with intravenous combination of ceftriaxone and ciprofloxacin for 3 weeks. One week later, IMR sent results that identified the strain as Salmonella enterica serotype Houtenae. Following antibiotic treatment, repeat ultrasound illustrated an improvement of the subdural empyema, and the gram stain of the CSF specimen failed to isolate bacteria.
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Affiliation(s)
- Amal Rashad Nimir
- Cyberjaya University College of Medical Sciences, Cyberjaya, Malaysia.
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16
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Chen KM, Lee HF, Chi CS, Huang FL, Chang CY, Hung HC. Obscure manifestations of Salmonella subdural empyema in children: case report and literature review. Childs Nerv Syst 2011; 27:591-5. [PMID: 20821214 DOI: 10.1007/s00381-010-1274-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Accepted: 08/24/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE Salmonella intracranial infections, including subdural empyema and brain abscess, are rare clinical manifestations in children. The aim of this study is to investigate the clinical course of Salmonella subdural empyema in infants and children. METHODS We report a 9-month-old female infant diagnosed as Salmonella subdural empyema with clinical features of prolonged fever for more than 2 months and episodic focal seizures. Literature published between 1986 and 2010 relevant to Salmonella subdural empyema in children were reviewed. The clinical presentations and laboratory findings were analyzed. RESULTS Seventeen cases with Salmonella subdural empyema, including our index case, has been reported with detailed clinical presentation. Fever (17/17; 100%), symptoms and signs of increased intracranial pressure (8/17; 47%), seizures (8/17; 47%), and limb paralysis (8/17; 47%) were the most frequent clinical features. Among these cases, unknown causative organism prior to surgery (11/17; 65%) and prolonged fever for more than 3 weeks (5/17; 29%) were also noticed. Sixteen out of 17 patients (94%) required surgical intervention for treatment. The morbidity rate and mortality rate were 29% (5/17) and 6% (1/17), respectively. CONCLUSION Subdural empyema is considered to be a disease with rapid progression. However, the cases caused by Salmonella species may present a slow disease course. Surgical intervention is sometimes the only way to detect the pathogen.
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Affiliation(s)
- Kai-Mao Chen
- Department of Pediatrics, Taichung Veterans General Hospital, No. 160, Sec. 3, Taichung-Kang Rd., Taichung, Taiwan, 40705
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Wu HM, Huang WY, Lee ML, Yang AD, Chaou KP, Hsieh LY. Clinical features, acute complications, and outcome of Salmonella meningitis in children under one year of age in Taiwan. BMC Infect Dis 2011; 11:30. [PMID: 21272341 PMCID: PMC3039577 DOI: 10.1186/1471-2334-11-30] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Accepted: 01/27/2011] [Indexed: 11/23/2022] Open
Abstract
Background Salmonella meningitis remains a threat to children below two years of age in both developing and developed countries. However, information on such infections has not been well characterized. We analyzed data related to twelve years of experience in order to clarify the comprehensive features of Salmonella meningitis in our patients, including admission characteristics, acute complications, and long-term outcome. Methods The records of patients with spontaneous Salmonella meningitis from 1982 to 1994 were retrospectively reviewed. The long-term outcome was prospectively determined for survivors at school age by the developmental milestones reported by their parents and detailed neurological evaluation along with intelligence, hearing, visual, speech and language assessments. Results Of the twenty-four patients, seizures were noted in fifteen (63%) before admission and thirteen (54%) during hospitalization. Acute complications mainly included hydrocephalus (50%), subdural collection (42%), cerebral infarction (33%), ventriculitis (25%), empyema (13%), intracranial abscess (8%), and cranial nerve palsy (8%). Three patients (13%) died during the acute phase of Salmonella meningitis. The twenty-one survivors, on whom we followed up at school age, have sequelae consisting of language disorder (52%), motor disability (48%), intelligence quotient < 80 (43%), epilepsy (33%), sensorineural hearing loss (17%), visual deficits (10%), abducens nerve palsy (5%), microcephaly (5%), and hydrocephalus (5%). Overall, good outcome was noted in six (28.6%) of twenty-one survivors, mild sequelae in three (14.2%), moderate in six (28.6%), and severe in six (28.6%). Conclusion Salmonella meningitis in neonates and infants had a wide spectrum of morbidity and acute complications, leading to a complicated hospital course and subsequently a high prevalence of permanent adverse outcome. Thus, early recognition of acute complications of Salmonella meningitis and a follow-up plan for early developmental assessment of survivors are vital.
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Affiliation(s)
- Hung-Ming Wu
- Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan.
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Ghais A, Armano R, Menten R, Mathot M, Zech F, Nassogne MC. Meningitis with subdural empyema due to non-typhoid Salmonella in a 9-month-old girl. Eur J Pediatr 2009; 168:1537-40. [PMID: 19266216 DOI: 10.1007/s00431-009-0963-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Accepted: 02/24/2009] [Indexed: 11/26/2022]
Abstract
We report a case of a 9-month-old baby admitted to the hospital because of low-grade fever, focal seizures in a context of watery diarrhea for 14 days' duration. The patient workup revealed a mild neutrophilic pleocytosis on cerebrospinal fluid (46 cells/microl), a positive stool culture for Salmonella pomona sensitive to ceftriaxone and ciprofloxacin, and a subdural empyema (SDE) on the cerebral MRI. The child received an intravenous third-generation cephalosporin for 4 weeks which resulted in cure. This case highlights an unusual extra-intestinal complication of non-typhoid salmonella infection. Involvement of the central nervous system with non-typhoidal salmonellosis is an important complication that can result in significant morbidity if not recognized and treated promptly. A focal intra-cranial infection must be considered in the differential diagnosis of any child presenting with focal seizures and gastroenteritis due to Salmonella. Appropriate diagnostic imaging of the head (cerebral CT scan with contrast and/or MRI) is mandatory to exclude the presence of an intra-cranial complication, even in the presence of negative CSF culture for Salmonella. Subfrontal and subtemporal SDE are sometimes missed on axial CT scans and better appreciated on MRI. Non-surgical treatment of small subdural empyemas with prolonged intravenous antibiotic therapy is a therapeutic option.
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Affiliation(s)
- Ahmad Ghais
- Cliniques universitaires Saint-Luc, Service de Neurologie Pédiatrique, Université catholique de Louvain, Brussels, Belgium
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Guillaumat C, Dang-Duy TL, Levy C, Cohen R, Leblanc A. Méningites à salmonelles du nouveau-né et du nourrisson. Intérêt des fluoroquinolones. Arch Pediatr 2008; 15 Suppl 3:S161-6. [DOI: 10.1016/s0929-693x(08)75501-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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20
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Oral infection of mice with Salmonella enterica serovar Typhimurium causes meningitis and infection of the brain. BMC Infect Dis 2007; 7:65. [PMID: 17597539 PMCID: PMC1925087 DOI: 10.1186/1471-2334-7-65] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2007] [Accepted: 06/27/2007] [Indexed: 11/22/2022] Open
Abstract
Background Salmonella meningitis is a rare and serious infection of the central nervous system following acute Salmonella enterica sepsis. For this pathogen, no appropriate model has been reported in which to examine infection kinetics and natural dissemination to the brain. Methods Five mouse lines including C57BL/6, Balb/c, 129S6-Slc11a1tm1Mcg, 129S1/SvImJ, B6.129-Inpp5dtm1Rkh were used in the murine typhoid model to examine the dissemination of systemic Salmonella enterica serovar Typhimurium following oral infection. Results We report data on spontaneous meningitis and brain infection following oral infection of mice with Salmonella enterica serovar Typhimurium. Conclusion This model may provide a system in which dissemination of bacteria through the central nervous system and the influence of host and bacterial genetics can be queried.
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Ailal F, Bousfiha AA, Jouhadi Z, Adnane F, Abid A. [Forty-one pediatric cases of non-typhoidal salmonellosis]. Med Mal Infect 2006; 34:206-9. [PMID: 16235596 DOI: 10.1016/j.medmal.2004.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED Non-typhoidal Salmonella (NTS) infections are a major cause of infantile death in developing countries. OBJECTIVE The aim of this study was to determine the epidemiologic and therapeutic data, as well as the evolution of NTS in Morocco. METHOD This retrospective study was made on 41 patients hospitalized for NTS between 1994 and 2002 in the Casablanca University Hospital Pediatric ward. RESULTS Twenty cases of digestive salmonellosis were diagnosed, 16 cases of septicemia, and 10 cases of meningitis. Ten patients were hospitalized after an outbreak of resistant Salmonella typhimurium in a nursery. Fifty percent of the patients were less than 3 months of age. The three patients between 1 and 3 years of age presented with primary immunodeficiency. Fever, vomiting, and diarrhea were noted in 97% of the cases. The stools were watery in 89% and severe dehydration in 55% of the cases. Salmonella strains were identified in blood in 25 cases, from stools in 10 cases, and from CSF in nine cases. The following Salmonella serotypes were identified: S. typhimurium (53.6%), S. enteritidis (44%), and S. agona (2.4%). Resistance to antibiotics was noted, especially for Salmonella typhimurium (34%) in the nursery outbreak. The evolution was favorable in 80%, but two children with meningitis developed severe neurological sequels, and six hypotrophic infants under 3 years of age died after septicemia.
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Affiliation(s)
- F Ailal
- Service de pédiatrie 1, hôpital d'enfants, CHU Ibn-Rochd, 20150 Casablanca, Maroc.
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Buoni S, Zannolli R, Di Bartolo RM, Macucci F, Migliorini L, Sansoni R, Cellesi C. Occipital intermittent rhythmic delta activity only following eye closure in atypical CNS Salmonellosis. Clin Neurophysiol 2005; 116:1768-70. [PMID: 15979938 DOI: 10.1016/j.clinph.2005.04.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2005] [Revised: 03/25/2005] [Accepted: 04/17/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE A statement recently published on the base of a large retrospective analysis, report that the occipital intermittent rhythmic delta activity (OIRDA) "is associated with epilepsy but not acute encephalopathy" [Gullapalli and Fountain. J Clin Neurophysiol 2003;20:35-41]. Our aim is to report, the exception from a child with an intermittent fever, in which the finding of an occipital intermittent rhythmic delta activity (OIRDA) following the eye closure in the EEG recording was the first clinical sign addressing to a CNS involvement. METHODS To review the record from a five-year-old girl with a normal basal electroencephalogram and OIRDA that only appeared following eye closure. RESULTS We found OIRDA associated with atypical CNS Salmonellosis. Brain MRI and CSF examination confirmed an acute encephalopathy, which was due to Salmonella infection. The only symptoms of the infection were episodes of nightly fever that had lasted for four weeks, sometimes associated with headache and vomiting. Both OIRDA only induced by eye closing and other symptoms disappeared after starting antimicrobial therapy. CONCLUSIONS OIRDA only following eye closure is a non-specific abnormality and the present findings, based on a single case, merely indicate that intracranial infection is among the possible causes. SIGNIFICANCE The new clinical association is certainly worth recording, as the presence of this electrophysiological sign may provoke clinicians to then delve further into a diagnostic work up.
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Affiliation(s)
- S Buoni
- Department of Pediatrics, Obstetrics and Reproductive Medicine, Section of Pediatrics, Policlinico Le Scotte, University of Siena, Siena, Italy.
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Drevets DA, Leenen PJM, Greenfield RA. Invasion of the central nervous system by intracellular bacteria. Clin Microbiol Rev 2004; 17:323-47. [PMID: 15084504 PMCID: PMC387409 DOI: 10.1128/cmr.17.2.323-347.2004] [Citation(s) in RCA: 144] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Infection of the central nervous system (CNS) is a severe and frequently fatal event during the course of many diseases caused by microbes with predominantly intracellular life cycles. Examples of these include the facultative intracellular bacteria Listeria monocytogenes, Mycobacterium tuberculosis, and Brucella and Salmonella spp. and obligate intracellular microbes of the Rickettsiaceae family and Tropheryma whipplei. Unfortunately, the mechanisms used by intracellular bacterial pathogens to enter the CNS are less well known than those used by bacterial pathogens with an extracellular life cycle. The goal of this review is to elaborate on the means by which intracellular bacterial pathogens establish infection within the CNS. This review encompasses the clinical and pathological findings that pertain to the CNS infection in humans and includes experimental data from animal models that illuminate how these microbes enter the CNS. Recent experimental data showing that L. monocytogenes can invade the CNS by more than one mechanism make it a useful model for discussing the various routes for neuroinvasion used by intracellular bacterial pathogens.
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Affiliation(s)
- Douglas A Drevets
- Department of Medicine, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma 73104, USA.
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Chang CJ, Chang WN, Huang LT, Huang SC, Chang YC, Hung PL, Lu CH, Chang CS, Cheng BC, Lee PY, Wang KW, Chang HW. Bacterial meningitis in infants: the epidemiology, clinical features, and prognostic factors. Brain Dev 2004; 26:168-75. [PMID: 15030905 DOI: 10.1016/s0387-7604(03)00122-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2003] [Revised: 06/02/2003] [Accepted: 06/09/2003] [Indexed: 11/17/2022]
Abstract
This 16-year (1986-2001) retrospective study enrolled 80 infantile patients (aged, 30-365 days old) with culture-proven bacterial meningitis. The most prevalent pathogens were Salmonellaspecies, Streptococcus (S.) agalactiae, Escherichia (E.) coli, and Haemophilus (H.) influenzae, accounting for about 59% of the episodes. Meningitis caused by Salmonella species, E. coli and H. influenzae occurs more often in the older infants, while that caused by S. agalactiae occurs more often in young infants. Our study revealed a decrease in the proportion of Salmonella meningitis from 27% in the first 8 years to 9% in the second 8 years with E. coli replacing Salmonella species as the leading pathogen of this disease during the second period. Overall mortality rate for both periods of time was 11%. However, if we take those with undesirable poor outcomes into account, 43% of patients could be considered treatment failures. The study also reveals a high prevalence of neurological complications when this disease is caused by H. influenzae, S. pneumoniae, and Salmonella species. Stepwise logistic regression analysis revealed that only initial changing levels of consciousness (P = 0.006) were independently associated with treatment failure. The most frequent neurological complications associated with this disease included subdural empyema, hydrocephalus, cerebral infarctions, and seizures. Because therapeutic regimens may require attention to the eradication of bacterial pathogen but also the neurological complications, early diagnosis and choice of appropriate antibiotics are essential to increasing the possibility of survival.
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Affiliation(s)
- Chin-Jung Chang
- Department of Pediatrics, Chang Gung Memorial Hospital-Jiayi, Jiayi, Taiwan
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Abstract
Bacterial meningitis is still a major cause of death and disability in children worldwide. With the advent of conjugate vaccines against the three major pathogens, the burden of disease is increasingly concentrated in developing countries that cannot afford the vaccines. Antibiotic resistance is an increasing problem; in developed countries, high-level resistance to beta-lactams among Streptococcus pneumoniae necessitates the addition of vancomycin to third-generation cephalosporins. In many developing countries, the problems are more fundamental. Increasing resistance of S. pneumoniae to penicillin and chloramphenicol and of Haemophilus influenzae to chloramphenicol means that many children with bacterial meningitis receive ineffective treatments, as third-generation cephalosporins are often unavailable or unaffordable. Case fatality rates are as high as 50% and neurological sequelae occur in one-third of survivors. The use of corticosteroids in meningitis is controversial; the evidence that they protect against neurological complications of childhood meningitis (particularly severe hearing loss) is strongest when: meningitis is caused by H. influenzae type b; dexamethasone is given before the first dose of antibiotics; a bactericidal antibiotic such as a third-generation cephalosporin is used; and in the early stages of the infection. There are few controlled clinical trials on which to base recommendations about other adjuvant therapy for meningitis. Avoidance of secondary brain injury from hypoxia, hypotension, hypo-osmolarity and cerebral oedema, hypoglycaemia or convulsions is essential for a good outcome. The problem of bacterial meningitis will only be solved if protein-conjugate vaccines (or other effective vaccine strategies) against S. pneumonia, H. influenzae and epidemic strains of Neisseria meningitidis are available to all the world's children. Making third-generation cephalosporins affordable in the developing world is also a necessary intervention, but better antibiotics will not overcome the problems of poor access to hospitals and late presentation with established brain injury, and will inevitably bring further pressure for antimicrobial resistance.
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Affiliation(s)
- Trevor Duke
- Centre for International Child Health, University Department of Paediatrics, Royal Children's Hospital, Flemington Road, Parkville, Victoria, 3052, Australia.
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Tejero García R, Rodríguez López F, Navarro Palos F, Muñoz Molinero J, Lacasa Díaz MJ, Ibarra de la Rosa I, Ortiz Vergara F, Casal Román M. [Meningoencephalitis due to Salmonella virchow with unsatisfactory outcome]. An Pediatr (Barc) 2003; 58:509-10. [PMID: 12724093 DOI: 10.1016/s1695-4033(03)78107-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Owusu-Ofori A, Scheld WM. Treatment of Salmonella meningitis: two case reports and a review of the literature. Int J Infect Dis 2003; 7:53-60. [PMID: 12718811 DOI: 10.1016/s1201-9712(03)90043-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Salmonella species now represent a leading cause of Gram-negative bacterial meningitis in the developing world. Various drugs have been used for the treatment of Salmonella meningitis over the past decades, but mortality, neurologic sequelae and relapse rates remain high. In this report we describe two children aged 8 and 9 months who presented within a week to our hospital with Salmonella meningitis. They were treated with penicillin and chloramphenicol but progressed rapidly to death within 48 h. AIM The aim of this article is to review all published English literature on the treatment of Salmonella meningitis and identify the best drug option for its treatment. This was done by comparing the outcomes such as cure, failure, relapse, and death rates. METHOD A Medline electronic search was carried out to find and retrieve articles that have been published since 1987, when the last review of Salmonella meningitis was done. RESULTS Salmonella typhimurium was the commonest organism reported, and 89.7% of infections occurred in children less than 1 year old. Fluoroquinolones had a cure rate of 88.9%, while the third-generation cephalosporins had a cure rate of 84.6%. Conventional antibiotics (chloramphenicol, ampicillin, and cotrimoxazole) had a cure rate of 41.2%, a relapse rate of 11.8%, and an associated mortality of 44.7%. Treatment with fluoroquinolone and imipenem resulted in no deaths. There were, however, only two cases that were treated with imipenem. CONCLUSION When Salmonella meningitis is suspected, third-generation cephalosporins, with or without a fluoroquinolone, may be the best option for treatment.
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Affiliation(s)
- Alex Owusu-Ofori
- Department of Child Health, Komfo Anokye Teaching Hospital, PO Box 1934, Kumasi, Ghana.
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Leonard MK, Murrow JR, Jurado R, Gaynes R. Salmonella meningitis in adults infected with HIV: case report and review of the literature. Am J Med Sci 2002; 323:266-8. [PMID: 12018670 DOI: 10.1097/00000441-200205000-00007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We report a case of Salmonella infantis meningitis in a patient infected with HIV who was successfully treated with 4 weeks of therapy and has had no relapses after 12 months of follow-up. Only 10 episodes of Salmonella species meningitis in patients infected with HIV are reported in the literature.
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Affiliation(s)
- Michael K Leonard
- Department of Medicine, Emory University, Atlanta, Georgia 30303, USA.
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Abstract
Salmonella enterica serovar Enteritidis is the cause of the food-borne salmonellosis pandemic in humans, in part because it has the unique ability to contaminate eggs without causing discernible illness in the birds infected. The infection route to humans involves colonization, survival and multiplication of the pathogen in the hen house environment, the bird and, finally, the egg. This review highlights the stages of transmission and discusses evidence that altered bacterial growth patterns and specific cell surface characteristics contribute to the adaptation of S. enteritidis to these diverse environments.
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Affiliation(s)
- J Guard-Petter
- US Department of Agriculture, Agricultural Research Service, 934 College Station Road, Athens, GA 30605, USA.
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Abstract
BACKGROUND The relative paucity of information about systemic nontyphoidal Salmonella (NTS) infection in infants without an underlying disease prompted this study. METHODS Infants without an underlying disease, who had positive cultures for NTS from their normally sterile sites during 1978 through 1998, were included. Their medical records were reviewed. RESULTS The study included 75 eligible infants; 68 (91%) had positive blood cultures. The spectrum of disease included transient bacteremia (5), bacteremia without localized infection (37), bone and joint infection (5) and meningitis (28); 53 and 88% of infants were < or =3 and < or =6 months old, respectively. All infants with localized infection were < or =7 months old, and infants with meningitis were 3.35+/-1.87 (mean +/- SD) months old. In bacteremic infants risks for localized infection and meningitis were 30 and 24%, respectively. Abnormal neurologic findings were the only predictor for meningitis. Relapse of meningitis occurred in two infants despite treatment with cefotaxime for 4 and 6 weeks. Severe neurologic deficit occurred in 21% of infants with meningitis. Of 11 infants with meningitis who received early treatment at this tertiary care center, 1 died but none had severe neurologic deficits; whereas of 17 referred cases, 2 died and 6 had severe neurologic abnormalities. No death occurred in infants without meningitis. CONCLUSION Systemic NTS infection in normal infants has a variable disease spectrum. Infants 0 to 6 months of age are at high risk for localized infection, especially meningitis.
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Affiliation(s)
- S Sirinavin
- Division of Infectious Disease, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Lee WS, Puthucheary SD, Parasakthi N. Extra-intestinal non-typhoidal Salmonella infections in children. ANNALS OF TROPICAL PAEDIATRICS 2000; 20:125-9. [PMID: 10945063 DOI: 10.1080/02724936.2000.11748121] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Extra-intestinal non-typhoidal Salmonella (NTS) infections are uncommon in developed countries but common in developing ones. The risk factors, clinical features and outcome of children admitted to the Department of Paediatrics, University of Malaya Medical Center, Kuala Lumpur from 1978 to 1998 with extra-intestinal NTS infections were reviewed. All positive cultures of NTS, blood, cerebrospinal fluid, urine, synovial, pericardial and other body secretions (except stools), were included. Of the 98 cases reviewed, 56 were boys and 42 girls. The mean age was 2.1 years (range: newborn to 14 years). Twenty-seven children were severely immunocompromised and 21 had underlying chronic medical disorders. Bacteraemia was the most commonly detected type of infection and meningitis the commonest focal infection. The overall mortality rate was 15%. An immunocompromised state or underlying chronic medical disorder was associated with increased mortality. The three serotypes most commonly isolated were S. enteritidis, S. paratyphi B and S. typhimurium. Most isolates were sensitive to antibiotics commonly used in salmonellosis.
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Affiliation(s)
- W S Lee
- Department of Paediatrics, University of Malaya Medical Center, Kuala Lumpur, Malaysia.
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